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Security Requirements Check List #: Common PS SRCL #15

Note: Please download and print the attached signed PDF version of the SRCL to use with your procurement. The HTML format of the following information is for viewing purposes only.

Contract Number

  • Common PS SRCL#15

Security Classification

  • Unclassified

Part A - Contract information

1. Originating Government Department or Organization

______________________________

2. Branch or Directorate

______________________________

3. a) Subcontract Number

______________________________

3. b) Name and Address of Subcontractor

______________________________

4. Brief Description of Work

______________________________

5. a) Will the supplier require access to Controlled Goods?

[  ] No
[X] Yes

5. b) Will the supplier require access to unclassified military technical data subject to the provisions of the Technical Data Control Regulations?

[  ] No
[X] Yes

6. Indicate the type of access required

______________________________

6. a) Will the supplier and its employees require access to PROTECTED and/or CLASSIFIED information or assets?
(Specify the level of access using the chart in Question 7. c)

[  ] No
[X] Yes

6. b) Will the supplier and its employees (e.g. cleaners, maintenance personnel) require access to restricted access areas? No access to PROTECTED and/or CLASSIFIED information or assets is permitted.

[X] No
[  ] Yes

6. c) Is this a commercial courier or delivery requirement with no overnight storage?

[X] No
[  ] Yes

7. a) Indicate the type of information that the supplier will be required to access

Canada [X] 
NATO [  ]
Foreign [  ]

7. b) Release restrictions

Canada:

No release restrictions [X] 
Not releasable [  ]
Restricted to: [  ]
Specify country(ies): __________________________________

NATO:

All NATO countries [  ]
Restricted to: [  ]
Specify country(ies): __________________________________ 

Foreign:

No release restrictions [  ]
Restricted to: [  ]
Specify country(ies): __________________________________

7. c) Level of information

Canada:

PROTECTED A [X] 
PROTECTED B [X] 
PROTECTED C [X] 
CONFIDENTIAL [  ]
SECRET [  ]
TOP SECRET [  ]
TOP SECRET (SIGINT) [  ]

NATO:

NATO UNCLASSIFIED [  ]
NATO RESTRICTED [  ]
NATO CONFIDENTIAL [  ]
NATO SECRET [  ]
COSMIC TOP SECRET [  ]

Foreign:

PROTECTED A [  ]
PROTECTED B [  ]
PROTECTED C [  ]
CONFIDENTIAL [  ]
SECRET [  ]
TOP SECRET [  ]
TOP SECRET (SIGINT) [  ]

8. Will the supplier require access to PROTECTED and/or CLASSIFIED COMSEC information or assets?

[X] No
[  ] Yes
If Yes, indicate the level of sensitivity: __________________________________

9. Will the supplier require access to extremely sensitive INFOSEC information or assets?

[X] No
[  ] Yes
Short Title(s) of material __________________________________
Document Number: __________________________________

Part B - Personnel (Supplier)

10. a) Personnel security screening level required

[X] RELIABILITY STATUS
[  ] CONFIDENTIAL
[  ] SECRET
[  ] TOP SECRET
[  ] TOP SECRET– SIGINT
[  ] NATO CONFIDENTIAL
[  ] NATO SECRET
[  ] COSMIC TOP SECRET
[  ] SITE ACCESS
Special comments: _________________________________
NOTE: If multiple levels of screening are identified, a Security Classification Guide must be provided.

10. b) May unscreened personnel be used for portions of the work?

[X] No
[  ] Yes
If Yes, will unscreened personnel be escorted?
[X] No
[  ] Yes

Part C - Safeguards (Supplier)

Information / Assets

11. a) Will the supplier be required to receive and store PROTECTED and/or CLASSIFIED information or assets on its site or premises?

[X] No
[  ] Yes

11. b) Will the supplier be required to safeguard COMSEC information or assets?

[X] No
[  ] Yes

Production

11. c) Will the production (manufacture, and/or repair and/or modification) of PROTECTED and/or CLASSIFIED material or equipment occur at the supplier's site or premises?

[X] No
[  ] Yes

Information Technology (IT) Media

11. d) Will the supplier be required to use its IT systems to electronically process, produce or store PROTECTED and/or CLASSIFIED information or data?

[X] No
[  ] Yes

11. e) Will there be an electronic link between the supplier's IT systems and the government department or agency?

[X] No
[  ] Yes
For users completing the form manually use the summary chart below to indicate the category(ies) and level(s) of safeguarding required at the supplier's site(s) or premises.
For users completing the form online (via the Internet), the summary chart is automatically populated by your responses to previous questions.

Table Summary

This table lists the Security categories as Information/Assets, Production, IT Media or IT Link. Protected A, B or C. And Classified Confidential, Secret or Top Secret for Canada.

SUMMARY CHART - Canada
Category PROTECTED CLASSIFIED
A B C CONFIDENTIAL SECRET TOP SECRET
Information / Assets            
Production            
IT Media            
IT Link            
Table Summary

This table lists the Security categories as Information/Assets, Production, IT Media or IT Link. Protected A, B or C. And Classified Confidential, Secret or Top Secret for NATO.

SUMMARY CHART - NATO
Category NATO
NATO RESTRICTED NATO CONFIDENTIAL NATO SECRET COSMIC TOP SECRET
Information / Assets        
Production        
IT Media        
IT Link        
Table Summary

This table lists the Security categories as Information/Assets, Production, IT Media or IT Link. Protected A, B or C. And Classified Confidential, Secret or Top Secret for COMSEC.

SUMMARY CHART - COMSEC
Category COMSEC
PROTECTED CONFIDENTIAL SECRET TOP SECRET
A B C
Information / Assets            
Production            
IT Media            
IT Link            

12. a) Is the description of the work contained within this SRCL PROTECTED and/or CLASSIFIED?

[X] No
[  ] Yes
If Yes, classify this form by annotating the top and bottom in the area entitled “Security Classification”.

12. b) Will the documentation attached to this SRCL be PROTECTED and/or CLASSIFIED?

[X] No
[  ] Yes
If Yes, classify this form by annotating the top and bottom in the area entitled “Security Classification” and indicate with attachments (e.g. SECRET with Attachments).

Part D - Authorization

13. Organization Project Authority

Name (print): __________________________________
Title: __________________________________
Signature: __________________________________
Telephone No.: __________________________________
Facsimile No.: __________________________________
E-mail address: __________________________________
Date: _________________________________

14. Organization Security Authority

Name (print): __________________________________
Title: __________________________________
Signature: __________________________________
Telephone No.: __________________________________
Facsimile No.: __________________________________
E-mail address: __________________________________
Date: _________________________________

15. Are there additional instructions (e.g. Security Guide, Security Classification Guide) attached?

[  ] No
[  ] Yes

16. Procurement Officer

Name (print): __________________________________
Title: __________________________________
Signature: __________________________________
Telephone No.: __________________________________
Facsimile No.: __________________________________
E-mail address: __________________________________
Date: _________________________________

17. Contracting Security Authority

Name (print): Jacques Saumur
Title: Contract Security Officer
Signature: __________________________________
Telephone No.: 613-948-1732
Facsimile No.: 613-948-1712
E-mail address: Jacques.Saumur@tpsgc-pwgsc.gc.ca
Date: February 2, 2017